Background Oesophagectomy is associated with: o Pre- and - - PowerPoint PPT Presentation

NUTRITIONAL ENHANCED RECOVERY:

post–pyloric feeding after discharge following oesophagectomy

RC McLean, J Sturrock, H Jaretzke, L Jones, N Hayes, SM Griffin

Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle

Background

• Oesophagectomy is associated with:
• Pre- and postoperative nutritional difficulties
• Protein-energy malnutrition (defined as >10% weight loss)

Postoperative nutritional enhanced recovery:

*Considerations to continue PPF after discharge: unable to maintain >50% of required caloric intake, preoperative weight loss >10%, oral route compromised, low preoperative body weight, clinically significant postoperative weight loss prior to discharge

Post-pyloric feeding (PPF) inserted at surgery: Surgical Jejunostomy Early introduction of enteral feeding: all patients Discontinued prior to discharge (Low risk of FTT) Overnight feeding following discharge (High risk for FTT*)

Methods

• This retrospective audit aimed to:
• 1. Describe weight changes following oesophagectomy
• 2. Investigate the influence of PPF following discharge on

postoperative weight changes and readmissions

• Reviewed notes 210 patients who underwent
• esophagectomy 1/1/12 – 30/4/14

Results

37 patients (17.6%) discharged home with post-pyloric feeding Median Post-pyloric Feeding (N=37) No feeding (N=173)

Duration after discharge 78 days Age 67 years 65 years Postoperative LoS 15 days 14 days Gender (male) 62.1% 73.8% Preoperative BMI (kg/m2) 24.6 26.0 (p=0.016*)

Change in weight: median weight loss vs. preoperative

<0.001** 0.364 <0.001** <0.001** <0.001** 0-2 weeks post D/C 0-6 weeks post D/C 0-3 months post-Op 0-6 months post-Op 0-12 months post-Op Discharge: PPF (%)

• 3.9%
• 3.2%
• 6.8%
• 8.0%
• 11.2%

Discharge: No PPF (%)

• 8.2%
• 9.8%
• 14.1%
• 12.8%
• 12.6%

p-value ‡

• 16.0%
• 14.0%
• 12.0%
• 10.0%
• 8.0%
• 6.0%
• 4.0%
• 2.0%

0.0%

Weight Loss (%)

Discharge: PPF (%) Discharge: No PPF (%)

‡ KW & post-hoc MW analyses with Holm’s correction

Change in weight: weight loss >10% vs. preoperative

0-2 weeks post D/C 0-6 weeks post D/C 0-3 months post-Op 0-6 months post-Op 0-12 months post-Op Discharge:PPF (N=37) 10.8% 24.3% 29.7% 43.2% 37.8% Discharge: No PPF (N=160) 20.0% 33.8% 33.8% 53.8% 42.5%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0%

Proportion of Patients with weight loss >10% (%)

Discharge:PPF (N=37) Discharge: No PPF (N=160)

Change in weight: median weight loss

0-2 weeks 0-6 weeks 0-3 months 0-6 months 0-12 months Discharge: PPF (Kg)

• 2.9
• 2.4
• 5
• 5.95
• 8.3

Discharge: PPF (%)

• 3.9%
• 3.2%
• 6.8%
• 8.0%
• 11.2%

Discharge: No PPF (Kg)

• 6.5
• 7.8
• 11.2
• 10.2
• 10

Discharge: No PPF (%)

• 8.2%
• 9.8%
• 14.1%
• 12.8%
• 12.6%

p-value

• 12
• 10
• 8
• 6
• 4
• 2

Change in Weight (kg) <0.001** 0.364 <0.001** <0.001** <0.001**

Readmissions: Failure to Thrive

Post-pyloric feeding No Post-pyloric Feeding p-Value Readmissions 18 64 0.359 Failure to Thrive 7 (38.9%) 42 (65.6%) 0.021*

Conclusions

• Oesophagectomy is associated with substantial

weight loss over a short period of time

• Post-pyloric feeding after discharge associated with:
• Significantly less weight loss
• Significantly fewer readmissions with failure to thrive
• This audit supports the implementation of PPF at

discharge in patients at risk of FTT